Provider Demographics
NPI:1306407168
Name:HEDSTROM, BETH LYNN (AGACNP-BC FNP-BC APN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:LYNN
Last Name:HEDSTROM
Suffix:
Gender:F
Credentials:AGACNP-BC FNP-BC APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-0025
Mailing Address - Country:US
Mailing Address - Phone:719-445-1411
Mailing Address - Fax:
Practice Address - Street 1:58128 HIGHWAY 330
Practice Address - Street 2:
Practice Address - City:COLLBRAN
Practice Address - State:CO
Practice Address - Zip Code:81624-9502
Practice Address - Country:US
Practice Address - Phone:719-487-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993767-NP363L00000X, 363LA2100X, 363LA2200X, 363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology